First, Let’s Get Comfortable Talking About Our Anatomy

I want to start with something simple.

We need to learn the correct names for our body parts.

Not because there’s anything wrong with humor or nicknames. Believe me, I enjoy a ridiculous nickname as much as anybody.

But because knowing your anatomy gives you the language to ask questions, explain symptoms, and advocate for your health.

Let’s start with a few basics.

The vulva is the external genital anatomy. It includes the labia, clitoris, vaginal opening, and surrounding structures.

The vagina is the muscular canal that extends from the vaginal opening to the cervix.

The urethra is the tube that carries urine from your bladder to the outside of your body. Its opening is separate from your vaginal opening.

The bladder stores urine.

The uterus is the muscular reproductive organ above the vagina, and the rectum is the final section of the large intestine.

And supporting these structures?

Your pelvic floor.

That’s where things get interesting.

Because the pelvic floor isn’t one little muscle that you’re supposed to squeeze a hundred times a day.

It’s a coordinated group of muscles and connective tissues that help support your pelvic organs and contribute to bladder control, bowel function, sexual function, and stability.

These structures work together.

And when something isn’t functioning well, the symptoms can show up in ways you might never have connected to your pelvis.

Your Pelvic Floor Is a Hammock of Muscles

During our conversation, Kim showed me the layers of the pelvic floor using her anatomical model.

And I loved it.

Because once you actually see these structures, so much starts to make sense.

Imagine a muscular hammock stretching across the bottom of your pelvis.

That hammock helps support your bladder, uterus, and rectum.

It also needs to coordinate with your breathing, abdominal muscles, hips, and nervous system.

Kim explained that clinicians often describe the pelvic floor in three layers.

The more superficial muscles are involved in functions around the vaginal and urethral openings, including sexual function.

The deeper muscles, including a group called the levator ani, provide important support and contribute to bladder and bowel control.

And here’s what I want you to understand.

These muscles have to do more than contract.

They also have to relax.

They need strength.

They need coordination.

They need flexibility.

They need endurance.

Just like muscles in other parts of your body.

If your shoulder doesn’t move properly, you don’t automatically assume the solution is to squeeze it harder all day.

So why have we been taught to approach our pelvic floors that way?

Why You Might Pee When You Jump, Laugh, or Sneeze

One of the most common concerns Kim sees in her practice is urinary leakage during exercise.

Jumping jacks.

Running.

Coughing.

Sneezing.

Laughing.

You know the moments.

You’re at the gym, you’re feeling strong, you’re doing your workout, and suddenly you’re wondering whether you should have worn a liner.

This is often called stress urinary incontinence.

And despite the name, it doesn’t mean emotional stress is necessarily causing you to leak.

It means urine escapes when physical pressure on the bladder increases and the continence system doesn’t fully compensate.

Kim talked about how pelvic floor muscles contain both endurance-oriented and quick-response muscle fibers.

Some help maintain support over time.

Others contribute to rapid responses when you cough, sneeze, or jump.

But urinary control involves more than muscle fibers alone. The urethra, connective tissues, nerves, and coordination between muscle groups all matter.

That’s why the best approach depends on what is actually causing your symptoms.

And here’s the important part:

Urinary leakage may be common, especially after pregnancy or with age, but that doesn’t mean you have to accept it without exploring treatment.

Pelvic floor physical therapy can help many women improve bladder control.

You deserve to know that option exists.

Urgency Is Different From Leaking When You Jump

Kim also described another experience that made me laugh because I know so many women will recognize it.

You’re driving home.

You pull into the driveway.

You get to the front door.

And suddenly your bladder acts like it’s an emergency.

You were fine five minutes ago.

Now you’re practically sprinting to the bathroom.

This is often called key-in-the-door urgency.

Urinary urgency is a sudden, compelling need to urinate. When that urgency is accompanied by involuntary leakage, it’s called urgency urinary incontinence.

That’s different from leakage caused by coughing or jumping.

And different problems can require different strategies.

Kim also brought up something I think many of us do without even thinking about it.

The just-in-case pee.

Before leaving the house.

Before the car ride.

Before the meeting.

Before the kids get on the bus.

We go to the bathroom whether we really need to or not.

For some people, repeatedly emptying the bladder at very low volumes can reinforce frequent bathroom habits.

Kim shared a tip about paying attention to how long you urinate.

I think the useful takeaway is to become aware of your habits rather than treating a specific number of seconds as a universal rule. Stream duration alone cannot reliably tell you whether your bladder was full or healthy.

If you’re experiencing frequent urgency, leakage, pain, or changes in urination, a qualified clinician can help assess what’s happening.

Because the goal isn’t to force your bladder to behave.

It’s to understand what it needs.

Let’s Talk About Painful Sex, Because Silence Isn’t Helping Anyone

The other major concern Kim sees in her practice is painful intimacy.

And ladies, this conversation is long overdue.

How many women have been told to just relax?

Or use more lubricant?

Or accept that sex becomes uncomfortable after childbirth or menopause?

No.

Painful sex deserves a real conversation.

There are multiple possible causes, including pelvic floor muscle tension, hormonal changes, dryness, irritation, infections, and other medical conditions.

One important distinction Kim made was between lubrication and vaginal tissue health.

Lubricants can reduce friction during sexual activity.

Vaginal moisturizers can provide longer-lasting relief from dryness.

And for some women, especially during perimenopause and menopause, prescription vaginal estrogen may help improve estrogen-responsive vaginal and vulvar tissues.

Kim specifically discussed vaginal estradiol and how it can be part of a broader treatment plan.

She also emphasized something I want every woman to know.

You do not have to wait until sex becomes unbearable to ask for help.

And you don’t have to wait until you’ve officially reached menopause to discuss symptoms with your healthcare professional.

Your comfort matters.

Your pleasure matters.

Your quality of life matters.

These aren’t frivolous concerns.

They’re health concerns.

What Happens to Your Pelvic Health During Perimenopause and Menopause?

We need to talk about estrogen.

Because estrogen influences more than reproductive function.

It also helps maintain the health of vaginal and vulvar tissues and contributes to the function of the lower urinary tract.

As estrogen levels fluctuate and eventually decline during the menopause transition, some women experience changes such as vaginal dryness, discomfort during intimacy, irritation, or urinary symptoms.

A collection of symptoms related to these changes is called genitourinary syndrome of menopause, or GSM.

Kim explained how local vaginal estradiol may help women experiencing these symptoms.

Unlike systemic hormone therapy, low-dose vaginal estrogen is primarily intended to treat local genitourinary symptoms, with relatively little absorption into the bloodstream.

It isn’t a replacement for pelvic floor therapy when muscle coordination or other mechanical issues are contributing to symptoms, but the two approaches can sometimes complement one another.

The right treatment depends on your symptoms, medical history, and preferences, and should be discussed with a qualified prescriber.

Kim also pointed out that some women experience vaginal dryness and discomfort while breastfeeding, when estrogen levels may be lower.

That’s an important reminder.

Pelvic health concerns aren’t exclusive to older women.

They can appear during different chapters of our lives.

And every chapter deserves attention.

Your Pelvic Floor and Your Hips Are Connected

This was one of my favorite parts of the conversation.

Because Kim and I both come from the physical therapy world, and I love talking about how the body works as a connected system.

Kim shared her own story.

After delivering her son, she experienced ongoing hip pain and eventually learned that she had torn the labrum in her hip.

She went through physical therapy and improved.

But something still felt incomplete.

As she learned more about pelvic health, she began recognizing connections between the hip and pelvic floor that hadn’t been fully addressed in her original rehabilitation.

During our conversation, she introduced a muscle called the obturator internus.

Now, this is where I get excited about anatomy.

The obturator internus is a deep hip muscle that helps externally rotate the hip and contributes to hip stability.

It sits along the inner wall of the pelvis, close to pelvic floor structures.

Because of those anatomical relationships, pelvic floor therapists may assess it when someone has certain patterns of hip or pelvic pain.

That doesn’t mean every hip problem comes from your pelvic floor.

But it does mean that sometimes the source of discomfort isn’t limited to the place where you feel it.

And that’s why a thorough assessment matters.

Your hips, lower back, abdominal wall, and pelvic floor don’t operate as isolated systems.

They work together when you move.

When you breathe.

When you carry your children.

When you exercise.

When you go about your day.

Understanding those connections can open the door to better treatment.

Please Stop Assuming More Kegels Will Fix Everything

Can we put this one on a billboard?

Kegels do not fix every pelvic floor problem.

Kim said it during our conversation, and I wanted to stand up and applaud.

Because somewhere along the way, women were given the impression that every pelvic floor issue could be solved by squeezing harder and more often.

Leakage?

Kegels.

Pain?

Kegels.

Postpartum?

More Kegels.

But here’s the problem.

Not every pelvic floor needs strengthening.

Some pelvic floor muscles have difficulty relaxing.

Others may be painful, poorly coordinated, weak, or some combination of these.

And if your pelvic floor is already overly tense, repeatedly contracting those muscles without addressing relaxation may make certain symptoms worse.

That’s why Kim emphasized assessing the muscles rather than assuming what they need.

Sometimes treatment focuses on strengthening.

Sometimes it’s relaxation.

Sometimes it’s coordination with breathing.

Sometimes it’s working on your hips, abdominal muscles, or movement patterns.

Sometimes it’s a combination.

The point is that your body deserves an individualized approach.

You don’t need to work harder at an exercise that may not be right for you. You need to understand what you’re trying to improve.

What Actually Happens During Pelvic Floor Physical Therapy?

I wanted Kim to walk us through this because I know one of the biggest barriers to getting help is simply not knowing what to expect.

And when we don’t know what to expect, our imaginations can get pretty creative.

So let’s take the mystery out of it.

Kim explained that a pelvic floor physical therapy appointment begins with a conversation.

Your therapist may ask about your symptoms, health history, pregnancies, surgeries, bladder and bowel habits, exercise, and any pain you’re experiencing.

They may also assess how your back, hips, abdominal muscles, and other areas move.

Because remember, this is all connected.

Depending on your symptoms, your therapist may recommend an external pelvic floor assessment or discuss an internal examination.

Kim explained that an internal vaginal assessment, when appropriate and agreed to, may involve a gloved, lubricated finger to evaluate muscle contraction, relaxation, tenderness, and coordination.

But here’s the most important part.

An internal examination is not something you have to agree to.

It requires your informed consent, and you can decline or stop it.

There is meaningful work that can be done through external assessment, education, movement, breathing, and other treatment approaches.

A good clinician should explain what they’re recommending, why it might help, and what your options are.

Kim also discussed biofeedback devices that can help some patients learn how their pelvic floor muscles are working.

These tools can be useful when they’re appropriate for the individual and accompanied by proper instruction.

And I loved that she emphasized education.

Because handing someone a device without helping them understand how to use it isn’t the same thing as empowering them.

The goal is for you to understand your body and participate in your care.

Not simply follow instructions without knowing why.

Perimenopause Isn’t the End of Your Story

Toward the end of our conversation, Kim and I talked about how women’s bodies change during perimenopause and menopause.

And I want to challenge the narrative that these changes somehow mean we’re becoming less capable, less relevant, or less ourselves.

Perimenopause can bring changes in menstrual cycles, sleep, mood, energy, and other aspects of health.

Some women notice pelvic or urinary symptoms during this time, too.

And the transition can be confusing.

Kim shared how she experienced postpartum changes and perimenopause close together.

Imagine trying to figure out which changes are related to childbirth, which are hormonal, and which are simply part of a demanding season of life.

That’s exactly why these conversations matter.

We need better information.

We need providers who listen.

And we need to stop treating women’s changing bodies like a personal failure.

Kim also shared something I found incredibly inspiring.

At 50, she earned her doctorate.

She ran her first Spartan race.

She built her own business.

I love that.

Because menopause isn’t the end of your value.

It isn’t the end of your strength.

And it certainly isn’t the end of your ability to do extraordinary things.

It’s another chapter.

One that deserves knowledge, support, and the freedom to decide what you want next.

Five Things I Want Every Woman to Know About Her Pelvic Health

If you remember nothing else from this conversation, remember these five things.

1. Learn the names of your anatomy.

Knowing the difference between your vulva, vagina, urethra, bladder, and pelvic floor helps you understand your body and communicate your concerns.

2. Urinary leakage deserves attention.

Whether it happens during exercise or when you’re rushing to the bathroom, there may be treatments that can help.

3. Painful intimacy is a legitimate health concern.

Don’t assume discomfort is something you simply have to tolerate after childbirth or during menopause.

4. Your pelvic floor needs coordination, not just strength.

More Kegels aren’t automatically the answer. Some muscles need help relaxing, and others need more targeted rehabilitation.

5. You are allowed to ask questions and seek another opinion.

If your symptoms are affecting your life and you aren’t getting helpful answers, keep advocating for yourself.

You deserve a clinician who takes your concerns seriously.

Women’s Pelvic Health Should Never Be a Shameful Conversation

Here’s what I want to leave you with.

We have spent far too much time treating women’s pelvic health like something private, embarrassing, or inappropriate.

And the result?

Women who don’t know their own anatomy.

Women who think leaking urine is just part of motherhood.

Women who avoid intimacy because it hurts.

Women who spend years dealing with discomfort without realizing that pelvic floor physical therapy even exists.

We deserve better.

And it starts with education.

With asking questions.

With having conversations that maybe our mothers and grandmothers never felt comfortable having.

With understanding that our bodies aren’t something to be ashamed of.

They’re something to be curious about.

Something to care for.

Something to understand.

I don’t want women shrinking away from conversations about their own health because someone taught them those subjects were inappropriate.

I want us to be informed.

I want us to feel empowered.

I want us to know that help exists.

And I want us to be able to talk about our pelvic floors with the same confidence we talk about our shoulders, knees, or backs.

Because it’s all anatomy.

It’s all health.

And it all matters.

Your pelvic health deserves attention, your questions deserve answers, and your body deserves care.

So ask the question.

Book the appointment.

Have the conversation with your girlfriends.

And whatever you do—

Don’t F*kn Shrink.

Health & Happiness,

Daffney Allwein
Host of Don’t F*kn Shrink Podcast

Listen to Don’t F*kn Shrink With Dr. Kim Dixon

If you’ve ever wondered whether urinary leakage is normal, why intimacy has become uncomfortable, or what pelvic floor physical therapy actually involves, this episode is for you.

Dr. Kim Dixon and I talk openly about pelvic anatomy, bladder control, painful sex, vaginal estrogen, hip and pelvic connections, Kegels, perimenopause, and what to expect when you see a pelvic health physical therapist.

It’s honest, educational, and judgment-free.

Listen to the full episode of Don’t F*kn Shrink with Dr. Kim Dixon, and share it with a woman who deserves to know more about her own body.

You can learn more about Dr. Kim Dixon through Pearl Physical Therapy and find her on Instagram at @ptkimdixon.